Thyroid is butterfly shaped organ located anteriorly in the neck in front of upper trachea. It
produces thyroid hormone, it regulates body metabolism.
Types of thyroid cancer
● Well Differentiated (Papillary and Follicular) Carcinoma Thyroid – most common
● Medullary Carcinoma Thyroid
● Anaplastic Carcinoma Thyroid – very aggressive
● Rarely: Undifferentiared, Lymphoma
Symptoms of thyroid cancer
● Thyroid cancer initially doesn’t cause any symptoms.
● Swelling in neck. Sometimes swelling is not in location of thyroid gland but on side of
neck which is because of enlargement of neck lymph nodes by thyroid cancer cells
● Change of voice because of pressure over nerves
● Difficulty in breathing because of pressure over windpipe
● Difficulty in swallowing food because of pressure over foodpipe
● Pain in neck or throat
● Sometimes recurrent loose motions can be a presentation in medullary thyroid cancer
● In some cases thyroid tumors are also asoociated with other tumors like adrenal tumor in
abdomen & parathyroid gland tumor in neck. Symptoms may be because of these tumors
like high blood pressure, pain abdomen, excessive sweating, kidney stones
Investigations for Thyroid Cancer
● Blood Tests includer Thyroid Function Test and Tumor markers like Thyroglobulin,
Calcitonin, CEA
● Ultrasound Neck: is initial imaging and most useful investigation to know the nature of
thyroid lesion
● FNAC usually done under Ultrasound guidance and helpful in confirming diagnosis of
cancer.
● CT Scan/ MRI/ PET CECT: to better characterize thyroid gland relations with nearby
structure and for spread to other organs like chest and abdomen. It may also identify other
associated tumors sometimes found in case of medullary thyroid carcinoma
● Laryngeal Examination: As thyroid put pressure over voicebox nerves
Some investigations may also be required to Check for associated tumors like in parathyroid
gland or adrenal gland
Treatment of Thyroid Cancer :
Main Stay of Treatment for Thyroid Cancer is Surgery of thyroid Gland. Two types of surgery
are advised – Thyroid Lobectomy & total Thyroidectomy
● Thyroid Lobectomy: Removes disease bearing side of thyroid along with middle part of
thyroid gland called isthmus. It preserves opposite healthy thyroid lobe. Lobectomy
decrease the requirement of lifelong thyroid hormone replacement requirement. Thyroid
lobectomy is usually done only for very small tumors which are around 1 cm or less and
no other high risk features or neck lymph node spread
● Total Thyroidectomy: Removes the thyroid gland completely.
o The recurrent laryngeal nerve can often by dissected away from the tumor
capsule, in most cases diseases can be removed away from these nerve but
sometimes in case of nerve involvement with nonfunctional vocal cord recurrent
laryngeal nerve may require nerve sacrifice. Voice box examination called
laryngoscopy is import to assess function of vocal cords before surgery.
o Disease over windpipe (trachea) mostly can be removed away but when cancer
goes inside trachea than resection of part trachea with rejoining is required
o Sometimes disease involve foodpipe which mostly can be treated with partial
resection
o Parathyroid glans are located posteriorly over thyroid gland, there are four glands
and these should be preserved always except in case of direct involvement by
cancer. These glands are responsible for calcium metabolism in body. Temporary
decrease in calcium level is common, rarely it can be permanent
o Patients with enlarged lymph nodes should undergo medial and lateral neck
lymph node dissection. Patient with larger tumors should also undergo same side
neck dissection and careful evaluation other lymph node regions their dissection if
required
o In low risk group with no nodes on imaging and intraoperative assessment, neck
dissection not required.
Risk Groups: High Risk: Females >45 yrs , Size > 1 cm, Incomoplete Resection, High Grade
tumor, Extrathyroid Spread, Lymph Node and distant organ mets
Low Risk: Complete excision Size <1 cm, No nodes/mets, Low grade histology, High-grade
follicular
I) Diagnosis after proper evaluation confirm on FNAC: Surgery
II) Diagnosis of thyroid Cancer after Thyroid Lobectomy Surgery: If low risk can be observed, If in high risk group than completion surgery
III) Diagnosis not confirmatory on FNAC: Frozen section analysis can be done at time of surgery. If positive than complete surgery. If negative no further treatment. If cancer on final report after surgery than appropriate surgery
If low risk and small tumor than Close monitoring
If high risk features than – Total completion Thyroidectomy
Radioactive Iodine Treatment: Not required in low risk group. In high risk group it is given 4-6
weeks after surgery.
Other Treatment Options : Radiation Therapy/ Chemotherapy/ Targetted therapy are palliative intent treatment options
when curative surgery is not possible
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